|
FIDAXOMICIN 200 MG TABLET [153338]
|
Facility
OP
|
$281.93
|
|
|
Service Code
|
NDC 52015-080-01
|
| Hospital Charge Code |
1712567
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$51.03 |
| Max. Negotiated Rate |
$239.64 |
| Rate for Payer: Adventist Health Commercial |
$56.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$150.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$155.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$211.45
|
| Rate for Payer: Blue Shield of California Commercial |
$175.08
|
| Rate for Payer: Blue Shield of California EPN |
$165.49
|
| Rate for Payer: Cash Price |
$126.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$183.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.64
|
| Rate for Payer: Dignity Health Senior |
$239.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.51
|
| Rate for Payer: Heritage Provider Network Senior |
$174.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$135.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.48
|
| Rate for Payer: Multiplan Commercial |
$211.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.64
|
| Rate for Payer: Vantage Medical Group Senior |
$239.64
|
|
|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
IP
|
$41.46
|
|
|
Service Code
|
NDC 52015-700-23
|
| Hospital Charge Code |
NDG229582
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Adventist Health Commercial |
$8.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.48
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.07
|
| Rate for Payer: Heritage Provider Network Senior |
$28.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.36
|
| Rate for Payer: Multiplan Commercial |
$31.10
|
|
|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
OP
|
$41.46
|
|
|
Service Code
|
NDC 52015-700-23
|
| Hospital Charge Code |
NDG229582
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$35.24 |
| Rate for Payer: Adventist Health Commercial |
$8.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.10
|
| Rate for Payer: Blue Shield of California Commercial |
$25.75
|
| Rate for Payer: Blue Shield of California EPN |
$24.34
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.24
|
| Rate for Payer: Dignity Health Senior |
$35.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.66
|
| Rate for Payer: Heritage Provider Network Senior |
$25.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.36
|
| Rate for Payer: Multiplan Commercial |
$31.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.24
|
| Rate for Payer: Vantage Medical Group Senior |
$35.24
|
|
|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
OP
|
$41.46
|
|
|
Service Code
|
NDC 52015-700-22
|
| Hospital Charge Code |
NDG229582
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$35.24 |
| Rate for Payer: Adventist Health Commercial |
$8.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.10
|
| Rate for Payer: Blue Shield of California Commercial |
$25.75
|
| Rate for Payer: Blue Shield of California EPN |
$24.34
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.24
|
| Rate for Payer: Dignity Health Senior |
$35.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.66
|
| Rate for Payer: Heritage Provider Network Senior |
$25.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.36
|
| Rate for Payer: Multiplan Commercial |
$31.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.24
|
| Rate for Payer: Vantage Medical Group Senior |
$35.24
|
|
|
FIDAXOMICIN 40 MG/ML ORAL SUSPENSION [229582]
|
Facility
IP
|
$41.46
|
|
|
Service Code
|
NDC 52015-700-22
|
| Hospital Charge Code |
NDG229582
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$31.10 |
| Rate for Payer: Adventist Health Commercial |
$8.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.48
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.07
|
| Rate for Payer: Heritage Provider Network Senior |
$28.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.36
|
| Rate for Payer: Multiplan Commercial |
$31.10
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [211102]
|
Facility
IP
|
$658.47
|
|
|
Service Code
|
NDC 61314-318-10
|
| Hospital Charge Code |
NDG211102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.18 |
| Max. Negotiated Rate |
$493.85 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.37
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$445.78
|
| Rate for Payer: Heritage Provider Network Senior |
$445.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.62
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$240.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$219.99
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [211102]
|
Facility
OP
|
$658.47
|
|
|
Service Code
|
NDC 61314-318-10
|
| Hospital Charge Code |
NDG211102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.18 |
| Max. Negotiated Rate |
$559.70 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$351.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$559.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$362.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$493.85
|
| Rate for Payer: Blue Shield of California Commercial |
$408.91
|
| Rate for Payer: Blue Shield of California EPN |
$386.52
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$559.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$559.70
|
| Rate for Payer: Dignity Health Senior |
$559.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.87
|
| Rate for Payer: Heritage Provider Network Senior |
$304.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$317.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.62
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$240.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$219.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$559.70
|
| Rate for Payer: Vantage Medical Group Senior |
$559.70
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [211102]
|
Facility
OP
|
$658.47
|
|
|
Service Code
|
NDC 61314-318-01
|
| Hospital Charge Code |
NDG211102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.18 |
| Max. Negotiated Rate |
$559.70 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$351.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$559.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$362.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$493.85
|
| Rate for Payer: Blue Shield of California Commercial |
$408.91
|
| Rate for Payer: Blue Shield of California EPN |
$386.52
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$559.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$559.70
|
| Rate for Payer: Dignity Health Senior |
$559.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.87
|
| Rate for Payer: Heritage Provider Network Senior |
$304.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$317.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.62
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$240.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$219.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$559.70
|
| Rate for Payer: Vantage Medical Group Senior |
$559.70
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [211102]
|
Facility
IP
|
$658.47
|
|
|
Service Code
|
NDC 61314-318-01
|
| Hospital Charge Code |
NDG211102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.18 |
| Max. Negotiated Rate |
$493.85 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.37
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$445.78
|
| Rate for Payer: Heritage Provider Network Senior |
$445.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.62
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$240.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$219.99
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [211101]
|
Facility
IP
|
$658.47
|
|
|
Service Code
|
CPT Q5101
|
| Hospital Charge Code |
NDG211101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.18 |
| Max. Negotiated Rate |
$493.85 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.37
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$445.78
|
| Rate for Payer: Heritage Provider Network Senior |
$445.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.62
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$240.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$219.99
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [211101]
|
Facility
OP
|
$658.47
|
|
|
Service Code
|
CPT Q5101
|
| Hospital Charge Code |
NDG211101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$493.85 |
| Rate for Payer: Adventist Health Commercial |
$131.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.94
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Cash Price |
$296.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Senior |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.87
|
| Rate for Payer: Heritage Provider Network Senior |
$304.87
|
| Rate for Payer: Humana Medicare |
$0.32
|
| Rate for Payer: IEHP Medi-Cal |
$7.46
|
| Rate for Payer: IEHP Medicare Advantage |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$493.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.35
|
| Rate for Payer: TriValley Medical Group Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$240.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$219.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.32
|
|
|
FINASTERIDE 5 MG TABLET [10037]
|
Facility
IP
|
$0.46
|
|
|
Service Code
|
CPT S0138
|
| Hospital Charge Code |
1711587
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.73
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.73
|
| Rate for Payer: Heritage Provider Network Senior |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
|
|
FINASTERIDE 5 MG TABLET [10037]
|
Facility
OP
|
$0.46
|
|
|
Service Code
|
CPT S0138
|
| Hospital Charge Code |
1711587
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$10.03 |
| Rate for Payer: Adventist Health Commercial |
$0.09
|
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Adventist Health Commercial |
$0.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California Commercial |
$0.29
|
| Rate for Payer: Blue Shield of California EPN |
$0.27
|
| Rate for Payer: Blue Shield of California EPN |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.49
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.39
|
| Rate for Payer: Dignity Health Senior |
$0.92
|
| Rate for Payer: Dignity Health Senior |
$0.39
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.67
|
| Rate for Payer: Heritage Provider Network Senior |
$0.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.92
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.39
|
| Rate for Payer: Vantage Medical Group Senior |
$0.92
|
|
|
FINASTERIDE (PROSCAR) CRUSHED PARTIAL TABLET IN STERILE WATER [4081461]
|
Facility
OP
|
$0.10
|
|
|
Service Code
|
CPT S0138
|
| Hospital Charge Code |
ERX4081461
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$10.03 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.06
|
| Rate for Payer: Blue Shield of California EPN |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.09
|
| Rate for Payer: Dignity Health Senior |
$0.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Senior |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.09
|
| Rate for Payer: Vantage Medical Group Senior |
$0.09
|
|
|
FINASTERIDE (PROSCAR) CRUSHED PARTIAL TABLET IN STERILE WATER [4081461]
|
Facility
IP
|
$0.10
|
|
|
Service Code
|
CPT S0138
|
| Hospital Charge Code |
ERX4081461
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.08
|
|
|
Fine needle aspiration biopsy, including CT guidance; first lesion
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 10009
|
| Min. Negotiated Rate |
$668.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$668.49
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$879.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Fine needle aspiration biopsy, including ultrasound guidance; first lesion
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 10005
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$174.24
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$879.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
Fine needle aspiration biopsy, without imaging guidance; first lesion
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 10021
|
| Min. Negotiated Rate |
$114.41 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$114.41
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$498.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
Fissurectomy, including sphincterotomy, when performed
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 46200
|
| Min. Negotiated Rate |
$63.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: Dignity Health Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,508.15
|
| Rate for Payer: Humana Medicare |
$3,508.15
|
| Rate for Payer: IEHP Medi-Cal |
$63.30
|
| Rate for Payer: IEHP Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,665.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,139.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,420.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,858.96
|
| Rate for Payer: TriValley Medical Group Senior |
$3,508.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery
|
Facility
OP
|
$7,436.00
|
|
|
Service Code
|
CPT 66170
|
| Min. Negotiated Rate |
$1,052.39 |
| Max. Negotiated Rate |
$7,436.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$1,052.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,532.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,202.79
|
| Rate for Payer: TriValley Medical Group Senior |
$2,911.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 15740
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$157.98
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,329.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,506.34
|
| Rate for Payer: TriValley Medical Group Senior |
$2,278.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
FLAVORX LIQUID [100560]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 86067-00047
|
| Hospital Charge Code |
NDG10056
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
FLAVORX LIQUID [100560]
|
Facility
OP
|
$0.12
|
|
|
Service Code
|
NDC 7857300074
|
| Hospital Charge Code |
NDG10056
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.09
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California EPN |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.10
|
| Rate for Payer: Dignity Health Senior |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.07
|
| Rate for Payer: Heritage Provider Network Senior |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Vantage Medical Group Senior |
$0.10
|
|
|
FLAVORX LIQUID [100560]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 86067-00047
|
| Hospital Charge Code |
NDG10056
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
|
|
FLAVORX LIQUID [100560]
|
Facility
IP
|
$0.12
|
|
|
Service Code
|
NDC 7857300074
|
| Hospital Charge Code |
NDG10056
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.08
|
| Rate for Payer: Heritage Provider Network Senior |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.09
|
|
